NT Health: 56 patients recommended for discharge, but aged-care system hinders plan

NT Health believes capacity constraints at its Darwin and Palmerston hospitals can be addressed by transitioning long stay patients into residential aged care – but aged-care shortfalls are hindering the plan.

Bellamack woman Maggie Grave, 76, with grandson Chilli. Picture: Supplied

NT Health believes capacity constraints at its Darwin and Palmerston hospitals can be addressed by transitioning 56 long-stay patients into residential aged care – but its efforts are being hampered by a chronic lack of available beds in the Commonwealth-administered aged care system.

In recent weeks, the Royal Darwin and Palmerston hospitals (RDPH) have been plunged twice into a ‘Code Yellow’ – denoting an internal emergency – due to too many patients and not enough beds.

Since July 1, 2020, there have been 19 internal emergencies declared at RDPH due to bed block.

While RDPH’s status as the Territory’s only tertiary health facility providing specialist services to the entire populace is a contributing factor, just as relevant is the “large number of long stay patients at RDPH, including aged care patients who have specialist needs or are awaiting placement in aged-care facilities,” a health spokeswoman said.

NT Health has identified 56 such patients at RDPH “who have been identified as suitable for permanent residential aged care”.

Since July 1, 2020, there have been 19 internal emergencies – Code Yellows – called at the Royal Darwin and Palmerston hospitals due to bed block. Picture: Pema Tamang Pakhrin

An average of two long-stay RDPH patients are transitioned to residential aged care each week, the spokeswoman said.

Although it was not immediately clear whether that rate of transition was swift enough to make headway in the overall headcount, given that new patients are admitted every day, some of whom will go on to become long stays.

However, the transition was being hindered due to “a shortage of residential aged care places” in greater Darwin, an issue faced across much of Australia, the spokeswoman said.

While planning is underway for a new 120-bed aged care facility in greater Darwin, its timeline is uncertain, and it may be years until it comes online.

According to figures provided by the federal Department of Health and Aged Care, of the 559 “operational places” in mainstream residential aged care homes in the Northern Territory, just 16 are vacant – or 2.86 per cent.

In greater Darwin, there are just four vacant beds ready to receive new residents – and Territorians are ageing faster than new beds are being added.

According to the most recent Productivity Commission Report on Government Services, the Territory has just 53.4 beds per 1000 residents aged 70 and older – the lowest in the federation.

Bellamack woman Maggie Grave, 76, with daughter Liz Howlett and grandson Chilli. Picture: Supplied

In 2014, it had 76.4 beds per 1000 residents aged 70 and older.

In its June 2019 submission to the Royal Commission into Aged Care Quality and Safety, NTCOSS, the Territory’s peak social services body, said this lack of available places had “resulted in many older people in long stay beds in hospitals while they await transition to a residential home”.

“Anecdotally, NTCOSS understands that people can wait up to several years until a residential bed is made available,” it said.

At the coalface, the delicate dance between the Territory-administered healthcare system and the Commonwealth-administered aged care system is causing some families great stress.

Bellamack woman Maggie Grave, 76, feisty and alert, but incontinent due to having part of her bowel removed – and only partially mobile due to a stroke suffered in her fifties – was admitted to Palmerston’s Geriatric Evaluation and Management (GEM) ward in January.

Despite no real improvement in her functionality, Ms Grave, who has no use of her left arm and only partial use of her left leg, was recently discharged to return to her public housing flat, where she lives alone.

“They are kicking her out even though they know she can’t manage on her own,” Ms Grave’s daughter, Liz Howlett, said.

Regis Tiwi Gardens aged care in Darwin. This bed is one of 559 mainstream aged care beds in the Northern Territory. Picture: supplied

While Ms Grave has an approved Home Care Package, it is meagre, meaning she will have to fend for herself for most of the day – maybe with the assistance of kindly neighbours.

“She has been home with incontinence pants, which she can’t get on or off on her own with only one arm,” Ms Howlett said,

“She will sit in her own waste for up to 23 hours a day.”

Ms Howlett said it is obvious to the family that Ms Grave needs to be transitioned to residential aged care – but RDPH dithering meant she only received an aged care assessment – the precursor to becoming eligible for residential aged care – on Friday.

“We have been fighting with the hospital since she was admitted, asking for them to do an [aged care] assessment so we can get her on a waiting list for nursing home as she is no longer capable of living on her own,” Ms Howlett said.

The family hopes the assessment will find Ms Grave eligible for residential aged care so they can banish the thought of their beloved mother, home alone, fighting her failing body as she tries to make it to the rest room.

Perhaps she will be one of the lucky ones: one in 10 Territorians found eligible are placed into residential aged care in seven days or less, according to the Productivity Commission.

But perhaps she won’t be: more than one in three wait for nine months or longer.